Control de síntomas por un equipo de soporte de cuidados paliativos. Resultados preliminares / No disponible

Objetivos: describir el grado de control sintomático de enfermos oncológicos terminales, basándonos en herramientas diagnósticas específicas (ESAS y HAD). Analizar si algunos síntomas se asocian con una menor supervivencia. Material y métodos: estudio longitudinal prospectivo de pacientes atendidos por el ESCP de Badajoz durante un mes. Se incluyen: índice de Karnofsky, fechas de primera visita, última visita y éxitus, ESAS inicial y final, HAD inicial y final y TQSS inicial. Para observar el grado de mejoría sintomática, desarrollamos el test apareado de comparación de medias (Stata9). Se utilizaron las tablas de Kaplan Meyer para el análisis de supervivencia. Resultados: se incluyeron 25 pacientes. El nivel de intensidad de los síntomas (ESAS) reveló Que inicialmente los síntomas peor controlados fueron la astenia: X = 5,3 (3,79-6,82), la tristeza: 7,35 (6,50-8,20) y el bienestar, 6,27 (4,90-7,64). Con la intervención del ESCP disminuyó la intensidad de los síntomas excepto la astenia. Cuando empleamos el cuestionario específico HAD para monitorizar la depresión y ansiedad, se comprobó: X = 23.21 (lC 95%,19,75.26,67), en la última visita 19,73 05,79-23,681. En relación a la existencia de disnea la mediana de supervivencia fue de 40 días, si no había disnea inicial, frente a 24, cuando estaba presente (p long. rank: 0,00071. Conclusiones: tras la intervención del ESCP se asistió a una mejoría sintomática, estadísticamente significativa en la depresión, ansiedad y bienestar. El ESAS y el HAD como herramientas diagnósticas fueron útiles para la monitorización de síntomas. La disnea y la depresión se asociaron con una supervivencia inferior (AU)

Objectives: to describe symptom control extent in terminally iII patients based on specific diagnostic tools such as the Edmonton Symptom Assessment System (ESAS) and Hospital Anxiety and Depression Scale (HADS). To analyze whether some symptoms are associated with poor survival. Material and methods: this was a longitudinal prospective study in terminally ilI patients fram Badajoz (Spain) who were included in the Regional Palliative Care Program. They were cared for by the Palliative Care Team for a month. Karnofsky Index, first inclusion visit, last visit and demise data, first and last ESAS control, first and last HADS score, and initial assessment with TQSS were collected. Also, to observe improvement in symptomatic control a matched mean comparison test was used. Finally, the Kaplan Meyer procedure was applied for a survival analysis. Results: twenty-five patients were included in the study. Initially, the worst controlled symptoms were asthenia X = 5.3 (3.79-6.82), sadness 7.35 (6.50-8.20) and well-being 6.27 (4.90-7.64). Alter care by a Palliative Care Team symptom severity decreased except for asthenia. We also used the HADS test for measuring clinical anxiety and depression, and obtained the following scores: first meeting X = 23.21 (95% CI: 19.75.26.67) and last visit 19.73 (15.79-23.68). Regarding how survival was affected by dypsnea, we observed that it was longer when dyspnea was not initially present (40 days and 24 days, respectively); log-rank p: 0.0007. Conclusions: there was a statistically significant improvement in symptoms such as depression, anxiety and well-being after a Palliative Care Team intervention. ESAS and HADS are two useful tools for monitoring symptoms. Short survival was associated with the presence of dyspnea and depression (AU)

Factores etiológicos de la disnea al final de la vida / No disponible

Objetivos: analizar los factores etiológicos de la disnea en una población atendida por un Equipo de Cuidados Paliativos (ECP) de ámbito de actuación mixta (hospitalario y domiciliario). Metodología: estudio longitudinal retrospectivo de los pacientes seguidos por el ECP de Badajoz y que fueron éxitus en el año 2005. Se reclutaron 195 pacientes, y se registraron las siguientes variables: edad, sexo, presencia de disnea, enfermedad terminal, localización del cáncer, factores etiológicos de la disnea: a) cardiopulmonar: (directa/indirecta); b) enfermedad concomitante; y c) causas sistémicas, saturación basal de oxígeno (SatO2), niveles de hemoglobina (Hb), índice de Karnofsky. El análisis fue realizado con el paquete estadístico Stata9, empleándose modelos de regresión logística. Resultados: el 60% de los pacientes presentaron disnea. La edad media fue de 73 años, el 64% eran mujeres; la enfermedad oncológica representó el 88% de los casos, siendo el cáncer de pulmón (n = 39) la neoplasia más frecuente. El odds de presentar disnea en los pacientes con afectación cardiopulmonar directa (1) e indirecta (2), era superior a aquellos que no referían disnea (OR1 = 0,1 OR2 = 0,05, p = 0,0001). El odds de la etiología sistémica fue > al 50% en pacientes con disnea (p = 0,052). No se demostró una asociación significativa entre SatO2 baja y disnea (p = 0,12). Los niveles de Hb ( < 11 mg/dl) se asociaron con la presencia de disnea (OR = 0,09/p = 0,005). Conclusiones: la afectación cardiopulmonar fue el factor etiológico más frecuente. Parece existir una asociación entre la etiología sistémica y la disnea. Los pacientes con cifras inferiores de Hb, mostraron mayor probabilidad de padecer disnea

Objectives: to analyze the etiologic factors of dyspnea in a population treated by a palliative care support team with both in-hospital and home activities. Methodology: a retrospective longitudinal study of patients included in a palliative care program within Badajoz health area who died in 2005. In all, 195 patients were recruited and the following variables were studied: age, sex, % patients with dyspnea, type of terminal disease, cancer site, etiologic factors of dyspnea (1. Local heart and lung (direct/indirect). 2. Associated disease. 3. Systemic causes). Oxigen saturation, hemoglobin level, and Karnofsky index. The analysis was performed using the statistical Stata9 method and logistic regression models. Results: sixty percent of cases showed dyspnea. Mean age was 73 (64% women). Cancer represented 88% of all cases (lung cancer was most frequent). The “odds” of dyspnea in patients with cardiac and lung disease, both direct (1) and indirect (2), were higher than in patients without that etiology (OR1 = 0.1 OR2 = 0.05, p = 0.0001). The odds of systemic causes were > 50% in patients with dyspnea (p = 0.052). The association was not statistically significant between oxygen saturation and dyspnea (p = 0.12). Hemoglobin levels were statistically associated with dyspnea (OR: 0.09/p = 0.005). Conclusions: the presence of cardiac and lung disease was the most prevalent etiology. Systemic causes were also associated with dyspnea. Patients with lower hemoglobin levels were more likely to suffer from dyspnea

[Report of a case of T-cell peripheral lymphoblastic lymphoma in an HIV patient]. / Presentación de un caso de linfoma linfoblástico periférico de células T en paciente VIH.

T-cell lymphomas in human immunodeficiency virus infections are rare, first case have being described in 1987, by Presant. Our purpose is to report the first T-cell Lymphoma case without epidermotropism in an HIV patient in Extremadura, and pioneer in Spain. Clinic extensive and histopathologic studies of cutaneous lesions were realized, including monoclonal antibodies tests. Peculiar clinical features were small bowel disease (MALT), gingiva, pericardium and skin involvement, with spontaneous resolution of skin nodules. Polychemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone was not effective, causing serious myelotoxicity. We outline the rarity of T-cell Lymphomas, the predominance of T4 phenotype, its relation with Epstein-Barr virus, the increase in 6-interleukin production, and the prognostic value of these factors, in correlation with advanced clinical status and unfavorable outcome.